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CAMHS won't see you now


The jury is out on whether private companies are a threat to general practice but it's best to be on the safe side and strive for that extra degree of excellence, says Dr John Couch

We seem to be receiving mixed messages about the dangers of private companies entering general practice.

A recent copy of the BMJ was rather alarmist in tone and some other sections of the medical press have also seemed uneasy. On the other hand, LMCs and the GMC are more reassuring: they seem to feel a large-scale threat is unlikely.

However, it does seem ironic that two previous GMC members and a well-known BMA solicitors firm have formed a consortium that has already successfully bid to run London practices.

One thing is certain. Whether private companies are a threat or not, it would be very foolish for GPs to be complacent.

Judging by the experiences of practices that have had battles with private companies bidding for vacant lists, it appears the bidding process may not always be fair. It is certainly the case that private bids with large corporate backing are more likely to be professionally presented. Every 'i' will be dotted and every 't' will be crossed throughout the 200-odd page document now necessary for a bid even to be considered.

Some of us may face this problem of competition sooner rather than later when the 2006/8 retirement bulge begins to take effect. But in a sense the timescale is irrelevant. We should not be waiting for a possible threat to materialise – we should be taking action right now. At worst, if no threat appears, your efforts will improve patient services at a politically expedient time. At best you will have safeguarded the future of general practice with GPs at the helm.

All practices therefore need to be making their service so good there will be no room for private companies to squeeze in.

The weapons most practices should be able to offer are continuity, experience and excellence. Unfortunately, the Government's major priority seems to be cost-efficiency. So practices must make sure they add this to their armoury. If they do so they will be unbeatable.

Size will matter

So far it is smaller practices that have been taken over. This is largely because these types of practices come 'on the market' much more, often due to the retirement of singlehanded GPs or to recruitment difficulties in deprived areas – practices tend to be smaller in deprived areas.

The way to stop vacant practices appearing is for GPs to forge stronger links with colleagues or to look to amalgamate.

Hitherto some practices may have been against this concept. A perceived threat from without is likely to change this attitude. Smaller practices that face retirements over the next two years should be looking at this option urgently. Then, when the GP does eventually retire, a larger group will be ready and waiting to assume responsibility.

If the GP was singlehanded and owned his or her own building the larger group could buy this. Alternatively they could move patients to their own premises so the smaller building could be sold more easily .

It may also be comforting to a retiring GP to know that their carefully built up list is remaining with traditional values rather than corporate ones!

Forming super-practices will not suit everybody. But even PCTs are now encouraging amalgamation and expansion, and it is stated NHS strategy that growing practices will receive preference funding. Small to medium practices lose nothing at all by at least exploring the options for expansion in their area.

Maintain continuity

At present, most GPs are partners and provide good continuity (although this has become diluted in some practices over the last two years – associate GPs, for example, move about fairly frequently). Continuity is now an important factor in the DES access patient surveys. It will also be a strong plus-point in bidding for vacant practices. And GPs have an advantage here. GPs can prove they offer continuity – a private company cannot.

So another important action point should be to review this question of continuity and make sure patients are able to see their named GP as often as possible.


In early years, privately-run practices are likely to function with younger salaried GPs (and probably nurse practitioners). Some older GPs, perhaps bought out by corporations, will take part, but generally patients in these practices will see younger faces.

While younger GPs are highly trained and very bright, most doctors improve with experience. I can remember the sceptical looks I received as a 20-something GP. Back then, many of my patients would return to their older 'trusted GP' for a second opinion. Now patients come to me for the same reason.

We must not forget this is a strong asset, if it is combined with good learning. A bid for a vacant list should emphasise this point.


There is a difference between doing a good job and doing an excellent job. Excellence is most definitely not the prerogative of older GPs. All traditional partnerships must regularly review their basic standards, education and, more importantly, the extra elements that make the best practices really shine.

Once again we have a head start over corporations. But be in no doubt that corporations who currently have a foothold will be striving to make their mark. Review your 'excellence' factor now and consider whether you need to make changes to stand out. This may be by increasing GPSI services or setting up clinics relevant to your area such as STD, teenage drop-in or men's health.


If there is one area where a private company can establish an advantage it is here. While GPs are generally good at running their businesses in a cost-effective manner, PCTs will be looking for something rather different.

They will want a better range of services to be provided at lower cost, especially services that can reduce secondary care referrals.

The most important objective for any bidder will be to gain the contract (because once achieved it will be harder to lose). To do this a private company may well make a 'low ball' bid and accept lower profit levels, at least in the first year or two. Existing practices will find this a bitter pill to swallow and a difficult policy to emulate.

Suitable premises will also be part of the contract, and if recent surveys are correct a large number of GP premises need investment. A private company will make capital investment part of their plans. How many of us are prepared to plough a sizeable part of our extra profits back into our businesses?

It is these areas where we need to focus hard. We need to take advice from our accountants, business consultants (or business managers in larger practices) and LMC/BMA. The PCT will look very carefully at all bidders' business plans and an unprofessional one will stand out.

Practices that have prepared carefully over the next few years are much more likely to guarantee their future success. Practices that are complacent may end up as prey. Watch out – there are lions out there!

John Couch is a GP in Ashford, Middlesex

GPs' competitive edge

What traditional GP practices have going for them

• Continuity of care

• Experience

• Quality of service

What traditional GP practices can do to make their position truly secure

• Expand – this provides

a stronger power base

• Maintain continuity of care –

patients appreciate it

• Achieve the highest possible

clinical standards

• Focus on cost-effectiveness

• Invest in premises

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